tci Medicare Compliance & Reimbursement - 2005 Issue 11
Long-Term Care: Providers May Have To Swallow Costlier Meds In 2006
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Article Overview
This article examines potential impacts of the Medicare prescription drug benefit on nursing facilities, especially for dual-eligible residents whose medications may be affected by coverage exclusions and state-level decisions. It also notes related HEDIS quality-measure proposals from the National Committee for Quality Assurance and why these policy changes matter to long-term care providers, pharmacists, and compliance teams.
Why This Topic Matters
Long-term care organizations need to understand how coverage changes and quality-measure updates could affect resident medication access, care continuity, and facility responsibilities. The article helps readers gauge policy developments that may influence pharmacy operations, payer coordination, and quality reporting.
Article Sections
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Coverage changes and long-term care impact
Discusses how the Medicare prescription drug benefit may affect medication access in nursing facilities and why state coverage decisions could matter in 2006. The section frames the issue for dual-eligible residents and long-term care providers.
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ASCP study findings
Summarizes findings from an American Society of Consultant Pharmacists study about potential care and cost implications. The discussion stays at a policy level and focuses on the study’s overall concerns.
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NCQA counterpoint and proposed HEDIS standards
Introduces the National Committee for Quality Assurance response and its proposed quality measures within HEDIS. This section explains the broader quality-reporting context without detailing measure specifics.
What You Will Learn
- How Medicare Part D may affect medication access in long-term care settings
- Why dual-eligible residents are a focal point of the coverage discussion
- How state decisions could influence drug coverage in 2006
- What role HEDIS quality-measure proposals play in the broader debate
- Which organizations are involved in the policy and quality standards discussion
Who Should Read This
- Long-term care providers
- Consultant pharmacists
- Nursing facility administrators
- Compliance and quality staff
- Health policy readers
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